For those known as the “familiar faces” most likely to dial 911, this island city across the bay from San Francisco is trying a new approach – getting in touch with them before they call.
“It changes the role we’ve traditionally had with folks,” said Patrick Corder, part of the local fire department’s Community Paramedic Program who used to spend his shifts racing to fires and accidents. “911 is purely reactive. This position is proactive.”
The program is part of the state’s two-year pilot study to look at whether local agencies can save money and improve lives by using firefighters and paramedics to check on the highest users of their services. A study of the program’s first year, 2016, showed a 37 percent decrease in visits by frequent users to the local hospital’s emergency department.
The program, administered by the state Emergency Medical Services Authority, involves 13 departments around the state that are using paramedics to check on people recently released from hospitals, admitted to sober centers, and are most likely to use emergency services. Only two agencies, in Alameda and San Diego, are enrolling the most frequent users of 911. While the program’s initial funding ends this year, there is pending state legislation that may extend it.
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These days Corder and another paramedic in the program can be found, as he describes it, “trying to put out figurative fires” – checking on about a half dozen regulars who might be homeless, recently released from the hospital or in precarious health.
One recent day began with a few calls to patients getting ready to leave the hospital and one to another who’d moved to Auburn but was still unsettled. A meeting was set up with a woman who had “graduated” from the program after 30 days but wanted to talk to Corder about her concerns over moving to an assisted living home.
“I promised her I’d follow up,” said Corder, sitting in his office in one of the buildings dotting a former military base on the island. “Her family wants her to move, and she has a lot of questions. She’s anxious.”
If his visit keeps the woman “happy and healthy,” and prevents her from needing to rely on 911 – as she’d frequently done in the past – he was glad to visit, he said. He will check her vital signs and whether she’s taking medications correctly, as he does on all home visits, but mostly what he does is “less medical and more social welfare,” he says.
Later in the day he will head to his fire-red car, which holds emergency medical supplies and equipment, make a hospital visit and then look for another man enrolled in the program who is homeless.
“I know where he’s likely to be,” said Corder. “Any one of three places.”
So far Corder has helped the man find a primary care doctor and get his prescriptions refilled. He’s also written a letter of support, requested by the public defender seeking to get a criminal charge reduced. With a cleaner record, Corder said, the man would have a better chance of getting housed.
“The thing that surprised me was the eagerness and willingness of paramedics to work on social needs and to be very patient and caring with folks who had mental illness and substance abuse,” said Janet Coffman, an associate professor at UC San Francisco School of Medicine and coauthor of a report on the pilot program.
Alameda, with a population of just under 80,000, enrolled 40 people in the first year and saved $8,114 a month in emergency department transports and visits, according to the report. Similar programs outside California have been successful in reducing hospital admissions, Coffman said, and there’s evidence a small program like the one in Alameda can work in larger cities.
She credited some of the programs’ success to “robust training” where paramedics learn how to recognize and handle needs of the high-risk population. Corder said it had given him a closer look at the complicated, inter-related health system. He now talks regularly with social workers at the hospital to enroll people who have little or no help when they’re released.
The program offers services to hospitalized people with chronic heart or lung disease, diabetes, pneumonia or sepsis. Once released, Corder and his partner might refer them to prevention services, meal programs or senior centers where they won’t be isolated. Not all interventions work. Some people in the program disappear or reject help.
“It’s not what I initially signed up for,” said Corder, who’d been in the department seven years when he volunteered for the program. But he found the assignment a good fit, both because he studied psychology in school and is from Alameda.
He and his partner have helped people get identification cards at the DMV and helped clean an unusually cluttered apartment. And they’ve attended funerals.
“It’s been a blessing in the way that I can really communicate with people and follow them at what is often the end of their lives,” Corder said. “A lot of people had their whole lives here. Sometimes I’m just there to be a witness.”
Katherine Seligman is a San Francisco-based freelance writer.